​​Diabetes Prevention Program

To enroll as a Fee-For-Service Medi-Cal provider, a Diabetes Prevention Program (DPP) must meet current Medi-Cal Provider Enrollment requirements and standards, the requirements set forth in this bulletin, and certain enrollment requirements and standards for Medicare Diabetes Prevention Program set forth in 42 CFR Section 424.205, as outlined below. DPP providers are required to submit their application via PAVE (Provider Application and Validation for Enrollment).

Included here is a powerpoint presentation​ to assist you with starting a DPP application in the PAVE system.  It also describes the application review process.

Requirements for Enrollment as a DPP

As a condition of enrollment, a DPP must have either pending, preliminary, or full recognition as a DPP through the Centers for Disease Control and Prevention. See 42 CFR 424.205, Requirements for Medicare Diabetes Prevention Program suppliers.

Additionally, the DPP must maintain at least one administrative location in California. An “administrative location” is defined as the physical location associated with the DPP’s operations, and where DPP services may or may not be furnished. See 42 CFR 424.205.

In accordance with the Centers For Medicare and Medicaid Services’ Federal Register, DHCS recognizes that DPP services can occur not only at administrative locations owned and operated by the applicant, but may also occur solely at “community settings.” A “community setting” is defined as a location where a DPP provider or applicant furnishes DPP services outside of their administrative locations (for example- a recreation center, community center, church basement, etc.) See 42 CFR 424.205.

All DPP applicants requesting consideration for enrollment must have at least one administrative location, and must report all administrative locations with their application package for enrollment.

Onsite inspections shall occur at the DPP provider or applicant’s administrative location, however, the DPP provider or applicant is not required to furnish DPP services at their administrative location. All other Established Place of Business requirements as set forth in CCR, Title 22, Section 51000.60 will apply to the applicant or provider’s administrative location.

DPPs may use peer coaches to provide DPP services to Medi-Cal beneficiaries. Peer coaches shall be dispatched from or based at the DPP’s administrative location. These coaches are required to obtain and maintain a valid National Provider Identifier (NPI) at all times. Additionally, a DPP coach must NOT:

• Currently have Medicaid or Medicare billing privileges revoked and must not be currently subject to the reenrollment bar;
• Currently have its Medicaid billing privileges terminated for-cause or be excluded by a State Medicaid agency;
• Currently be excluded from any other Federal health care program, as defined in 42 CFR 1001.2, in accordance with section 1128, 1128A, 1156, 1842, 1862, 1867 or 1892 of the Act;
• Currently be debarred, suspended, or otherwise excluded from participating in any other Federal procurement or non-procurement program or activity in accordance with the Federal Acquisition Streamlining Act implementing regulations and the Department of Health and Human Services non-procurement common rule at 45 CFR part 76;
• Have, in the previous 10 years, any of the following State or Federal felony convictions.
• Crimes against persons, such as murder, rape, assault, and other similar crimes for which the individual was convicted, as defined under 42 CFR 1001.2, had a guilty plea or adjudicated pretrial diversion.
• Financial crimes, such as extortion, embezzlement, income tax evasion, insurance fraud and other similar crimes for which the individual was convicted, as defined under 42 CFR 1001.2, had a guilty plea or adjudicated pretrial diversion.
• Any felony that placed Medicare or its beneficiaries at immediate risk, such as a malpractice suit that results in the individual being convicted, as defined under 42 CFR 1001.2, had a guilty plea or adjudicated pretrial diversion of criminal neglect or misconduct.
• Any felonies for which the individual was convicted, as defined under 42 CFR 1001.2, had a guilty plea or adjudicated pretrial diversion that would result in mandatory exclusion under section 1128(a) of the Act.     

If a DPP is found to be utilizing a peer coach who does not meet these standards, the DPP’s application for enrollment may be denied. See 42 CFR 424.205.

Currently enrolled Home Health Agencies, Community Outpatient Hospitals, Physicians, Physician Groups, Federally Qualified Health Centers, Rural Health Clinics, Free Clinics, Community Clinics, Multispecialty Clinics, County Clinics Not associated with Hospitals, Otherwise Undesignated Clinics, Home and Community Based Services Nursing Facilities, Outpatient County Hospitals, and Indian Health Services may request to provide DPP services by submitting a complete Supplemental Change request using PAVE, along with their valid, current CDC Pending or Preliminary Recognition letter or certificate of Full CDC Recognition and a typed roster of all peer coaches, which includes each coach's full name, NPI number, birth date, and Social Security Number.

Additional application requirements

In addition, Diabetes Prevention Program applicants must submit all of the following items with their application for enrollment:

• A cover letter expressing their request for enrollment as a Diabetes Prevention Program and a list of all administrative location(s) of the DPP provider or applicant;
• A copy of the DPP applicant or provider’s valid, current, CDC Pending or Preliminary Recognition letter, or a current valid copy of their Certificate of Full CDC Recognition. Providers are required to obtain and maintain this recognition/certification at all times. Loss of pending, preliminary, or full recognition will result in removal from participation in the Medi-Cal program;
• A typed roster of all peer coaches which includes each coach’s full name, NPI number, birth date, and Social Security Number;
• Newly enrolling DPP applicants must attach a copy of a prefilled DOJ Request for Live Scan Service (BCIA 8016) form for each required individual with their application, date stamped and showing verification that all fees have been paid by either a “PAID” stamp from the public Live Scan operator or a receipt of payment. For details on the process as well as who is required to submit the BCIA 8016, please see the provider bulletin entitled “Medi-Cal Requirement to Submit Fingerprints for a Criminal Background Check”
• In accordance with the Centers for Medicare & Medicaid Services’ Calendar Year 2022 Physician Fee Schedule Final Rule​, DPP providers are no longer considered institutional providers. Therefore, all applications received on or after January 1, 2022, will no longer require an application fee.